We have created a question & answer bank on the basis of the information our patients have frequently sought from us. However, it is possible that your question does not find place here. If so please do not hesitate to contact us. Our panel of experts will send you a reply as soon as possible and we will add your query to the bank, if we find that it is of common relevance.

Cancer cells differ from normal cells in that they have the ability to infiltrate surrounding normal tissue. Small clumps of cancer cells may break off from the parent growth and be carried by the blood or lymphatic flow to other parts of the body and become established as secondary growths, known as metastatic deposits.

What causes cancer ?
There is no single causal relationship for cancer. In experimental animals many agents, including chemicals, hormones, viruses and radiation, have produced cancer. There is a casual relationship between tobacco consumption and head and neck cancers. According to the W.H.O., 90% of the people who suffer from head and neck cancers have used tobacco in some form or the other.

Is there any relation between tobacco/alcohol and cancer causation ?
Nicotine absorption is faster in presence of alcohol. The severity of the ill effects is of a greater degree if tobacco and alcohol are consumed together. French epidemiologists have shown that the combined use of alcohol and tobacco can cause cancers of the larynx and pharynx.

Tobacco is associated with increased incidence of head and neck cancers. In India, the very high incidence of cancers of the mouth is due to the rampant tobacco chewing habits. Poor oral hygiene may also play a role. A sharp edge of a tooth can, over a long period of time, cause dangerous ulcers on the inner lining of the cheek, the buccal mucosa.

Do germs cause cancer ?
Many researchers believe that some viruses may play an important role in causing cancer. Specific epidemiological data is available for nasopharyngeal and cervical cancers.

Is cancer infectious ?
No. Cancer does not spread by direct or indirect contact with another person.

Can cancer be caused by injury ?
No. Injury, such as pathological fractures, may, however, make cancers noticeable.

How does cancer spread to other parts of the body ?
There are three basic mechanisms of its spread:

• By direct extension to surrounding structures.
• Through blood circulation
• By lymphatic flow

How fast can it grow ?

• There is a wide variation in rate of growth of tumour at different sites.
• Different types of cancers will behave differently.
• Individual host factors may also be responsible for slow or fast growth.

Is cancer increasing ?
According to some, the number of new cancer cases diagnosed each year, per thousand of our population, is slowly increasing. Some say that it may be because of increased life spans and better diagnostic facilities.

Can children get cancer ?
Yes. Though relatively rare, children can have cancer. Leukemia is the most common cancer in children.

Is all tumors cancer ?
No. The word “tumor” means swelling or lump caused by localized growth of cells. Those tumours, which do not have the potential to spread to other organs are harmless and are termed ”benign”. Tumours that spread to other organs of the body are called “malignant or cancerous”.

Is pain an early symptom of cancer ?
No. In fact, often it is not an early symptom. In some cases cancer can cause pain at a late stage, when it invades the bone or compresses nerves. A painless lump warrants further investigation. Cancerous lumps in the breast can be painless to begin with. However, remember that all lumps need not be cancerous.

What are the danger signals ?
There are no sure symptoms and signs of early cancer. In the early stages, cancer and other illnesses cause a number of problems that may be similar. However it is important to seek medical advice if the following symptoms persist for more than two weeks

• Altered voice, persistent cough, hoarseness
• Difficulty in swallowing that is gradually increasing
• Change in bladder or bowel habits, blood in the urine or stools
• Lump any where in the body, often increasing in size
• Unusual bleeding or discharge, post-menopausal bleeding
• Non healing sores
• Obvious change in the size or pigmentation of a wart or mole. Melanomas are aggressive cancers.
• Unexplained weight loss.

What are the methods for early detection of pre-cancers of head and neck ?
We encourage monthly self-mouth examination in high-risk population, particularly tobacco users. It is important and relatively easy to detect oral cancers early. Treatment is more effective in the early stages, before the disease has spread to other organs.
Mouth self-examination means looking in a mirror to check for:

• A sore in the mouth that does not heal
• A lump or thickening in the mouth
• A pearly white patch or a red patch on the gums, tongue or buccal mucosa

Other symptoms are:

• Soreness or choking sensation in the throat
• Difficulty in chewing or swallowing
• Difficulty in tongue movements

It is important to see a specialist if the symptoms last for more than two weeks.

What about the methods for early detection of other cancers ?
For breast cancer, self-breast examination and mammography are recommended as methods for early detection.

Cancer of the uterine cervix can be detected early if women of the reproductive age group undergo periodic gynaecological examination and a Pap test is done on a yearly basis.

What is the treatment for cancer ?

Cancer can be treated by

• surgery
• radiotherapy
• chemotherapy
• biological therapy (immunotherapy).

The doctor may use any one method or a combination of them. The choice of treatment depends on the

Type of cancer

• Location of the tumor
• Stage of the disease, patient's age, general health and a number of other factors.

How long a patient can live if untreated ?
The life of an untreated patient is shorter than that of a treated patient. The quality of life is also very poor.

What is a biopsy? How much tissue is removed for a biopsy ?
A small piece is surgically removed from the affected tissue and is examined under a microscope to determine if it is cancer. Pre-cancerous conditions of the oral cavity such as leucoplakia can also be detected by a biopsy.

What is the time taken for a biopsy ?
It depends on the procedure selected for the biopsy. A proliferative growth of the buccal mucosa can be biopsied in seconds. If the patient requires a surgical procedure like an endoscopy, for e. g. a direct laryngoscopy, or an examination under anesthesia or an open surgical procedure then more time will be required.

Will I be awake during the biopsy?
A biopsy may be performed under local anesthesia, while the patient is awake, or under general anesthesia, as per the area from where the biopsy is to be taken, doctor's discretion and sometimes the patient's preference.

What if the biopsy shows a cancer, whom do I talk to ? When ?
Once the diagnosis is made, one should immediately contact an oncologist.

If I am to undergo surgery, what should I expect ?
A head and neck cancer surgery involves removal of the affected part and lymph glands in the neck, and the surgical procedure is extensive. In the immediate post surgical period there may be a swelling over the operated part. It takes about two weeks for the immediate problems to settle down.

Will I have trouble eating ?
Yes. For a few weeks, there might be some trouble in eating solid food and the patient may have to be on a special diet.

Will there be a permanent change in my appearance ?
This will depend on the initial extent of surgery. If the volume of tissue to be removed is large then there might be a permanent change in appearance.

Will I need plastic surgery ?
All patients do not require plastic surgery. Only if a surgical defect is anticipated, does the operating team consider the option of reconstructive plastic surgery. The aim of reconstructive surgery is not only cosmetic but also functional recovery.

How about my speech ?
Speech may get affected if a patient is operated for cancer of the tongue or larynx and s/he would require post-operative speech therapy.

How soon will I be able to get back to work ?
If patient undergoes surgery and receives adjuvant radiotherapy, s/he may be back to normal work in three months.

What is radiotherapy ?
Radiotherapy is the use of radiation in the treatment of cancer. Radiation does not hurt. There is nothing to see or feel. The patient is positioned on a couch and the machine, which produces x-rays, gamma rays or electrons, is directed precisely onto the tumour bearing area. The entire session takes one or two minutes.

Cancer cells are vulnerable and are easily damaged and slowly decrease in number. The normal cells sustain radiation over a period of time and recover to their healthy form. Therefore, repeated daily treatments are prescribed.

Is it necessary for me to under go radiotherapy ?
Yes. The chances of local recurrence are reduced with adjuvant radiotherapy. However, it is better to let your oncologist take the decision.

What is the length of external radiotherapy ?
Daily treatment takes only one or two minutes. And overall treatment time may extend from six to seven weeks.

Can't it be of a shorter duration ?
The duration depends on the aim of the radiotherapy. If the aim is curative, then one has to receive therapy for six to seven weeks. Palliative radiotherapy is usually of a shorter duration. Accelerated fractionation of radiotherapy may conclude therapy in a shorter span and will also cure cancers in specific cases.

Why is radiotherapy given 5 days a week ?
It is a convention to give radiotherapy for five days a week with two rest days for recovery of normal tissue.

How will I feel during therapy ?
Depending on the site of irradiation some side effects may be encountered. A radiation oncologist is able to help the patient get over these side effects.

Is radiotherapy safe ?
Today, radiotherapy is safer than ever before.

What can be done to minimize side effects ?
Acute side effects are temporary and usually subside within a few weeks. By and large radiation reactions persist till the end of therapy and some time there after and can be minimized with the use of proper medication .

In addition to these acute reactions, there are some late effects of radiotherapy. These reduce over a period of time and often disappear completely.

Please consult your radiation oncologist for detailed information.

How will my mouth and face look after radiotherapy ?
There may be a temporary or permanent loss of hair in the irradiated area. Color of the skin might change a little bit. There will be dryness of mouth.

Is there anything that can be done for dryness of mouth ?
There are various preventive methods to deal with dryness of mouth after irradiation.

1. shielding of the parotid glands as much as possible without compromising the treatment of the tumour.
2. Judicious use of medicines to prevent dryness of mouth.
3. Gene therapy- selective protection of parotid gland.

What is rehabilitation ?
Rehabilitation is a very important part of treatment for patients with head and neck cancers. Every effort is made to help the patient return to normal activity as soon as possible.

Rehabilitation includes:

• Dietary counseling
• Dental prosthesis
• Speech therapy & other services, which are a part of physical rehabilitation

Learning to live with the changes brought about by extensive surgery for cancer of larynx is a special challenge and requires a high level of self-motivation.

What is the future of clinical and laboratory research in the field of head and neck cancers ?
Today, the focus is on genetic research.

How much gap should there be between biopsy & cancer treatment ?
There should not be a gap or an unnecessary delay between the biopsy and initiation of cancer treatment.

How do I know if I have a likelihood of getting a recurrence?
Please consult your doctor for information.

Can non-tobacco users get cancers of the head and neck?
Yes. But, the probability is low.

Help line service of the Indore Cancer Foundation

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